Newborns in sub-Saharan Africa: how to save these fragile lives.

• Author: Mason, Elizabeth
• Position: Reduction child mortality

Every day in Africa, 2,400 babies are stillborn and another 3,100 newborns die within their first four weeks of life. Half of African women and their babies do not receive skilled care during childbirth and even fewer receive effective post-natal care. (1) To achieve the fourth Millennium Development Goal (MDG 4)--to reduce the under-five mortality rate by two thirds from the 1990 rate by 2015-much more needs to be done to prevent neonatal deaths.

Why are so many newborns dying in sub-Saharan Africa? The causes are relatively few. Birth asphyxia, preterm birth and infections account for 87 per cent of newborn deaths in Africa (see graph on page 61). Mortality overall is higher in Africa than in other regions of the world. The underlying social determinants that contribute to the causes of newborn deaths are poverty, low levels of maternal education and inequities in access to quality health care. Also, until recently, there has been insufficient attention paid to neonatal health and it has received relatively little funding in relation to the large numbers of deaths. Part of the problem has been a lack of reliable information on how many newborns are actually dying, since births and deaths are not always registered. It is estimated that as many as half of African newborns who die go unregistered, invisible to national and regional policies and programmes. It is very difficult to deliver the interventions to those who need them if we do not know where they are.

In many African communities, babies are not named until six weeks of age and may not be considered as individuals and brought into society until they are older. Some newborns are considered "visitors", especially in countries with high mortality rates. In October 2007, the Health Metrics Network, hosted by the World Health Organization (WHO), launched a campaign to encourage countries to improve their vital registration systems, in order to count all births, deaths and causes of death.

What can be done to reduce newborn deaths in Africa? It makes no sense to assist a mother, but not the newborn, during childbirth, or to provide care for a child while ignoring the mother's health. Reducing newborn deaths requires two continua of care: from pregnancy (and even before) through childbirth and into childhood; and from the family and community to first-level health facility and on to referral facilities. This continuity requires greatly strengthened health systems with maternal, newborn and...